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Beth Garvey: I can take question number 12. So, so we did negotiate legislation as part
of the budget, it was, in collaboration with both houses to assure that we would continue
to provide liability in situations where there was gross negligence modeled on our
state's Good Samaritan laws, understanding that we were in an emergency situation.
We were across the state, having surge capacity issues. We were requiring facilities to
set up care for patients in places like cafeterias and other areas where they normally did
not provide patient care, so there were obviously myriad concerns associated with the
liability around that. When, when the legislature passed a law to further restrict that in
May, we signed it. We, on May 8 also repealed our executive order that initially granted
immunity for the healthcare practitioners who had come in from out of state because at
that point in time we were also no longer having practitioners come from across the
country into New York as many other states started to experience their own surges. So
we're open if you want to have a conversation about further changes or amendments to
that law. We're happy to have that conversation with you.
Assemblyman Kim: Well, I appreciate that. Thank you. I think, I think the point is, that
there was an executive order, I forgot the exact number, on March, 23, that spoke to the
Good Samaritan law to allow volunteers to come in and be protected but between
March 23, and the proposal that got enacted in April 2, it was broadened beyond the
scope of volunteers that included, you know, trustees, shareholders, the board
members, it went retroactive to march to non-COVID hospitals and nursing homes. And
we felt like it was very broad and retroactively we took away patients' and nursing
home residents' rights. So I do appreciate the Governor signing the bill to modify the
immunity, in July, but, like, like you just said, I mean I think we have other suggestions
to hold some of the bad operators accountable retroactively, so we'll share some notes
in the near future.
Melissa DeRosa: I think that if there is any evidence that anyone was willful or anyone
was negligent in a way that goes beyond the normal course that costs people's lives, I
think that they, we all share the same goal, which is to hold them accountable. I think a
lot of these nursing homes, frankly retrospectively even prior to COVID have been
getting away with a lot for a lot of years. And I think that this can be a useful
conversation in changing that dynamic. So I completely agree and I think Beth should
follow up with you, Assemblyman, and leadership to see what we could do.
Assemblyman Kim: Thank you Ms. DeRosa, and then to that point I think you're aware
of the St Albans nursing home with the veterans nursing home site that give out
experiments with drugs to a bunch of veterans and one of them passed away. I think the
Governor did comment on it yesterday. So in those types of facilities, I think those
families should definitely have some sort of retroactive justice.
Melissa DeRosa: Dr. Zucker, do you want to speak to that specific instance?
Dr. Zucker: I'd like to comment about that because that issue at St Albans was the
issue of the hydroxychloroquine, right. Number one, that was -- the state was not
ordering that and that's a doctor patient relationship a decision about what to do. But
more important, or as important, I should say, is the fact that we have to remember that
the context of this. Initially, we were looking for any possible therapy that could help
individuals with COVID. At that point the thought was hydroxychloroquine with
Azithromycin may help. And so that was provided as an option. When the data showed
that that was not the case, the science obviously realized that that was not beneficial.
The recommendation was not to continue to use that. So I think it's important to be clear
why that was being given at that point and again it was not the state doing that. And it
was also a doctor patient relationship to decide what therapy should be given.
Senator Skoufis: Can I jump in on that similar point but not specific to an individual
nursing home, that you mentioned -
Senator Rivera: 14 out of 17 -- we're almost there.
Senator Skoufis: Sorry. Secretary DeRosa, you mentioned working to hold these
nursing homes more accountable. And I couldn't agree more. And I think probably most
of us, if not all of us on this call, here agree. And we've got some bills moving to that
end. But I don't know if we've got to this in your responses, yet but one of the responses
spoke to the inspections that were done the infectious control, sort of surveys that were
done during the pandemic, the violations that were found. So 2,200 and
change inspections, I think, 170 violations, which seems low given sort of the
knowledge that we're all operating within the AG's report. It would at least appear that
there are far more bad actors than just 170 out of some 2,200, but that aside, 170
violations, 11 were cited at the immediate, Jeopardy level, whatever that means. So just
a couple of questions on that. One, you mentioned, Commissioner, at the hearing seven
months ago six months ago, I think the number was 1,300 at that point. Since you
mentioned that I've been trying to find any information related to the results of those
surveys. We can't, my office can find anything, whether it's cumulative or an individual
nursing home level. Are you going to be releasing or can you if you have not, I request it
I guess, if you haven't, can you give us some information, even if it's aggregate, related
to what those violations are. Can you speak to what was the highest fine that you've
issued from all those violations? Were any nursing home licenses revoked? You know, I
think, again, we're all operating with this knowledge that there were some really bad
actors, and I like to think, you know, in those most egregious of situations that we pull
licenses, have we?
Dr. Zucker: So I can, I will work on getting you the data and the specifics of that, the
highest fine - maybe Beth, do you know?
Beth Garvey: So when you look at the fines that we've levied, it's been over a million
dollars. I think it's $1.3 million. We are still in enforcement proceedings on a number of
these. The important thing to note about those infection control surveys, they're done in
partnership with CMS so I think we do have to check federally whether there's any data
restriction on data that we collect there, so we'll try to get you some aggregate
information. What makes it very difficult, those 2,284 are just point in time. So to the
extent that we have inspectors in those facilities, we are making sure that they are
following proper infection control protocols there. We're also looking for compliance with
other executive orders while we're there. So we may ask to see, you know, evidence of
negative tests of visitors, for instance, to the extent that they're visitors in the facility or
making sure that there are no visitors, things of that nature. So to the extent that when
we're there, if there's not a violation that we observe we cannot cite it. That said,
separately we do investigations based on complaints separately, so we do follow up on
any complaints that we receive or any leads that we get whether it's from staff, or from
families or from the long term care ombudsman. So, the, the strata of penalties are
pretty low, overall for nursing homes. So when you see a violation, theoretically any one
of these violations could lead to, you know, significant adverse health outcomes for
someone and they tend to be pretty limited. We are assessing $10,000 penalties. We
are for those immediate jeopardy. That is a revocation of licensure. So, that can result in
a receiver being appointed or it can result in someone actually losing their license. So,
those are most egregious.
Senator Skoufis : Has it happened at all?
Beth Garvey: It has not happened. We have significant due process, obviously for
those operators, that we have to go through in hearing. So those are still ongoing. And
we do not have at this juncture, you know, any receivers appointed right now.
Senator Skoufis: Okay. I appreciate that information and I think you know, you
acknowledged the 1.4 million and I get it, there's still some more enforcement action
happening, but divided by 170 that's like $8,000, per violation. I think that amounts to a
slap on the wrist and so to the extent that we could all work--
Beth Garvey: The $10,000 is really the maximum that we can assess for a violation,
even a willful violation of a public health law. So I think what Melissa was trying to jump
in and say—
Melissa Derosa: Yeah I was gonna say, I think that that's something we should revisit. I
think, then we should be increasing the penalties, and I think that if also this process is
dragging on this amount of time as a result of all this, I'm not suggesting we shouldn't
have due process. But if there is a way that we can change the law where we can
expedite some of this, we should do it. And to the extent that you've been asking for that
information and you haven't got it I'm sorry and can we please get it to the Senator right
after this to the extent that is federally allowable. And if it's not let's just explain why it's
not.
Senator Skoufis: I appreciate that, thanks. Just to be clear, I mean you. And obviously
a law is preferable as legislators here, but you could have adjusted those penalties
through an executive order, right?
Melissa DeRosa We did some Beth, right?
Beth Garvey: We said that we would take your license and appoint an operator, which
was really an extraordinary relief that was not available to us under the law, because so
many of the executive order restrictions that we've put in are not contained otherwise in
law, we're stuck with 12 D for willful violations, so that's a $10,000 penalty. Obviously
we can, you know, try to wrap those up and do multiple $10,000 violations, what we're
doing right now with the homes is we're trying to settle for maximum penalties and in
fact, we've gotten a lot of letters from them asking us to ease up on the
inspections, ease up on the penalties. You know we're fining people for failure to report
to HERDS timely, we're fining people if they don't have adequate PPE on hand. So, we
are finding multiple violations and we're trying to really stay on top of everything right
now and so it's on multiple fronts. So the nursing homes right now have been very
critical of us, and they are responding very litigiously and digging in their heels because
what they want to see this be is more of a collaborative enforcement structure, and right
now we're obviously holding everyone to the letter of the law and our executive orders.
Assemblyman Kim: Okay. Gustavo, I know you got three more questions, but -
Senator Rivera: No -- I just want to be clear, it's a free flowing thing. I just figured since
there were 17 we should go through them, but go ahead.
Assemblyman Kim: You should definitely go through. I just gotta hop off, I'm sorry, but
just to summarize, I think I'm gonna go through the questions, Commissioner and Ms.
DeRosa, I'll probably have some follow up with them as well. But just moving forward, I
think the public just wants to get past this. Commissioner when you, when you came to
see us in the Assembly chamber last year, and you wanted to expand the Governor's
powers and we asked for $40 million to get ahead of the coronavirus, many of my
colleagues did not want to do that, they did not want to give the Governor those
powers. I was one of the few ones that stood up for the Governor. And so it's this is not
about whether you personally like him or not like him. This is a moment that we need to
cheer him on, but we need to get behind this executive, because everyone is scared
and everyone wants someone to step in and do this right, and I had a lot of faith that we
were going to get it right. But over the last few months I think we did lose a lot of trust.
Because of lack of communication, for the lack of that, I know we went through all the
reasons why. And I just want to get past this. I want to move forward. And I want to get
solutions, and I know that we touched on a few items but before I leave, I mean if we
can just follow up. Legal immunity, a possible sort of compensation funds for the
victims, a structure, some of civil framework a discussion around that. The ombudsman
program, someone just mentioned it. I know that Senator May has been passionately
talking about giving that some teeth, so they actually have the power to do their jobs.
The increasing penalties was just mentioned, and some sort of a recognition, and
maybe an apology for the March 25. I know this is something that is a sensitive issue,
and no one wants to talk about it, but I think the families, the public I think just
recognize, appreciate some sort of honesty, but just, just the recognition of their pain,
and I think some sort of contriteness from the Administration would go a very long way.
So that's all I have for today, I really appreciate your time, I know you're all very busy.
Thank you so much and I'll follow up with other questions. Thank you.
Senator Rivera: I know the 14 had to do with testing, which we dealt with a little bit
earlier as far as nursing homes, but there's one thing related to pooled testing, I have to
admit that I don't necessary know what that means, but is there a role for it,
Commissioner could you tell me about that?
Dr. Zucker: Sure. The pool testing works if there's a relatively low prevalence in the
community. So it really depends on where you are, and that's one of the things that you
have to look at when you're moving forward. When our numbers were coming back
down, when our numbers were high, that was not necessarily beneficial way to do
things. Sometimes this is used in college settings or other aggregate settings. So we
can always look at that. There are specific [inaudible] that have been developed by labs
certified by the FDA to do that kind of testing and we can address that further with you.
But it is very specific to what the prevalence is in the community.
Gareth Rhodes: I would note that each month more and more labs bring on pool
technology. Some of the largest reference labs in the country now are using pool
technology for a large number of their tests that happen. SUNY as I'm sure you've seen,
they've processed hundreds of thousands of tests over the course of a semester using
pooled technology. So it has become a much more common way of testing with each
growing month. I think you see this in the turnaround times now -- close to 90% of tests
are resulted back within 48 hours. The testing capabilities in terms of rapid testing, in
terms of expedient PCR testing, lab-based it's really night and day from where it was
last summer into spring.
Senator Rivera: Gotcha. And there's actually a part of that question at the end which
relates to actually question 16 - not that I'm skipping 15, but that has to do with the raw
data, which again relates to 3 and we're going to have- that's a big one and it is not
going to go away for the moment. But both the end of question 14 and 16 deal with
federal dollars, specifically on testing on question 14 having to do with testing and more
broadly on 16 related to nursing homes. Could you tell us a little bit about some of the
federal dollars that now, thank the Lord that we actually have a damn president who
gives a shit about us, how some of that- what are the discussions related to some of
that money flowing to nursing homes, whether it's testing, or other things related to
nursing homes?
Rob Mujica: So, the federal government, you know, they were changing on a weekly
basis, right, some of their what was eligible for funding, but now it seems with the new
administration that they are- they have changed their tune significantly on what the
eligible expenses are and on the state match or local match that's required. So we're
trying to fit as much into- there were like three pots of money but the FEMA
reimbursement now, that's now making testing available, essentially, for reimbursement
depending on what type of testing, all the vaccination costs now eligible. So, the short
answer to your question is, everything that we can do to get federal reimbursement or
anything that's eligible, we're going to get reimburse the homes for. So if there's any
costs that we can use or give the nursing homes and help them with their fiscal issues,
right, and we can get reimbursement from the feds, we're going to try to maximize the
federal reimbursement and we're getting a much better - we think - a better result. They
have advanced - not yet, but they said they were advancing some dollars to us and,
again, we're trying to make everything that we can make eligible for reimbursement,
we're trying. And we think, to your point, this administration seems more responsive to
what the costs are and it goes both for nursing homes, hospitals and just general costs
associated with COVID. So, we're going to continue to try to maximize that and make it
available to the homes because we know that some of- a lot of these costs are
expensive.
Senator Rivera: So, on 17 again, and after this I'm just going to take a step back and
I'm sure that some of my colleagues might have some more follow ups or more going
deeper into certain things but the last one here, on 17 relates to a question Senator
Thomas asked on Article 81 Guardianship, which again, not something I'm necessarily
all that familiar with, but I know that Senator Thomas cared enough to actually give us a
scenario here that he wanted to actually deal with it, and it has to do with access to folks
who are in this program and whether they had limited access based on the needs of
keeping people out of congregate settings. Can you tell us a little bit about this and
where we are with this now?
Beth Garvey: So, I can take this question, so I think that the question was driving at
whether or not a Guardian would have access and so anyone who was recognized as a
Guardian would have the same access as anyone who is authorized to visit someone in
a nursing home. So, for instance, if it was someone in an end of life situation, I think this
was driving at a period of time when we did not have visitation, and so a Guardian
would be able to visit if the individual could have say a family member visit, and I know
that courts were particularly challenged when it came to hearing some of these cases,
but guardianship cases were always essential and so courts were trying to do these
hearings virtually. I certainly don't want to minimize the difficulty of anyone trying to
navigate the system throughout those dark months there, but I think that things are very
much back in order now with respect to that, and that should all be clear. So if Senator
Thomas has anything you know, that's a continuing fact-specific issue, we'd be happy to
work with him on it.
Senator Rivera: I'll check in with him about that because I'll be honest, that's not one
that I've that I've actually checked back with him on. So, I'm good for the moment. I'll
take three steps back.
Senator May: Okay, I'm going to jump in then because I do have a question and I've
only been able to skim your answer about the March 25th guidance. And I understand
where you're coming from on that and I think I understand the curve issue and that sort
of thing. But, you don't seem to refer to the key point in the AG's report where they say
that there were 4,000 deaths after that guidance in nursing homes, including in 323
facilities that had no known infections before that guidance came out. And so, the AG's
report seems to be - even though you're right, there is a lot of language in there about
how you were following the CDC guidance and everything else, there also seems to be
language linking that decision to additional deaths in nursing homes. And this is the
issue that people, I think, most want to know about when they bring that guidance up
that DOH issued then. Are you going to respond directly to what the AG's report says?
Do you have a response to that?
Melissa DeRosa: Sure. So, Senator, I'm happy to take this one. The AG has since
updated her report. She did it quietly, she didn't tell anyone. She tipped a couple of
news outlets and then they put up a story saying the AG's office updated their report.
That was wrong information, which we would have been happy to tell her had she told
us with more than one hour notice of putting out her report. So, that was incorrect
information. We brought that to their attention after they put it out. They went back and
reviewed all of the data and they have since updated their report and I'm happy to make
sure, Dana, if you could send the Senator a copy of the report and also the news report
where it says they removed that line because that was actually not true. There was
prevalence of COVID in all but three facilities in the state prior to an admission of a
COVID positive patient. So, the statement that there were 4,000 deaths following March
25th, that's true, however there was 4,000 deaths post-March 25th. In the fall there had
been 3,000 deaths, 2,500 deaths, and we all know that that order has since been
clarified going back all the way to May 10th. Although the AG's office also in their report
says very clearly that, through their investigation they found that operators were very
well aware of the fact that that guidance did not supersede their underlying legal
obligation to not allow somebody to come into their facility that they themselves could
not care for, which meant they had to be able to have the proper amount of PPE; they
had to segregate; they had to have separate sets of staff. So, on that point specifically,
I'm actually really happy that you raised it. She has since revised her report to take that
out because they did that based on faulty data, but they did it quietly and they didn't tell
anyone. There was no press release announcing that, so we can get that for you but to
make the record perfectly clear, there was COVID prevalent in all but three nursing
homes in New York State before a COVID positive admission. So, COVID was already
in the facility before they accepted a patient from a hospital or from another facility
where they knew they were COVID positive. Does that answer your question?
Senator May: It does except that, if she was quiet about it why were you quiet about it I
guess is my question? It seems like this is something you would want people to know
and understand and that goes back to this —
Melissa DeRosa: It was actually in the response that Dr. Zucker had put out the day of
but obviously so much of the focus was on the number that that almost wasn't even part
of the conversation. But in Dr. Zucker's response that he issued the day of, he clarified
that point and then she since revised her report. But I'm happy to make that more clear.
I obviously know what you're getting at, you're hearing from constituents who are
saying, "but this," so moving forward we can be more clear in pointing that out. If you
guys have direct lines to Tish and you want to ask her to be more vocal about that as
well, but the report has since been updated and I'm happy to get that so you can see it.
Senator May: Great. Thank you.
Melissa DeRosa: Of course.
Assemblyman Gottfried: I have a couple of questions. You're under court order to give
the Empire Center their FOIL request.
Melissa DeRosa: Assemblyman, it went out about five minutes ago. We wanted to do
this briefing with you guys before we send them that.
Assemblyman Gottfried: Okay. Well my question is- well, you've answered the first
part of my question which is, have you sent it to them?
Melissa DeRosa: Yes, five minutes ago, and again just so you understand why waited,
it's because we wanted to brief you guys first.
Assemblyman Gottfried: Yes, that's fine. The second part of my question is, would
you now email it to each of us?
Melissa DeRosa: Of course.
Assemblyman Gottfried: Okay. Thank you. Please do. My second question is, in our
August letter, the 5th question and last question from the Assembly was that, if you
don't have the various pieces of data that we asked for in our first few questions, and it
appears just to say it briefly that you say you don't. If you don't have that information, if
you're not getting that information, do you have or do you lack the legal authority by
modifying HERDS or something else, to make sure that hospitals and nursing homes
provide you the information that we've asked for. I assume that in the last many months
since we sent you the letter somebody in the Executive Branch has been looking at that
question. So, do you have the authority to start getting the information we've asked
about from hospitals and nursing homes or do you lack that authority?
Beth Garvey: I think, Assemblyman, if I could take that one. So, I think we would have
the authority to alter the HERDS data and in fact we have altered HERDS at different
points throughout the pandemic. I think all of that comes with particular challenges and
I'll certainly let Dr. Zucker speak more particularly to what those challenges are but,
from a continuity perspective, it becomes very difficult when we change how we ask a
question. We're asking them to attest under penalty of perjury. Different people are able
to interpret that question sometimes differently and we can get wildly different answer.
And so at the times where we've changed the survey, even what we think is a slight
change, it can dramatically change how facilities report in to us and lead to, you know,
several days or even weeks of trying to then figure out where the miscommunication is;
why some facilities are now increasing their reporting and some facilities are now
decreasing in ways that we're not expecting. So, you know, it becomes a challenge that
we tend to only add on to what we've already asked to make sure that we continue to
get the same data for continuity purposes, and so again, as we talked about a little bit
earlier, the facilities are continually complaining about the changes in reporting, the
need for frequency and reporting, and the disparate reporting between state and federal
requirements. So, yes, we can change it. It's always a little bit fraught to change the
reporting though. Dr. Zucker?
Dr. Zucker: I think, Beth, I think that you covered it all. In this also, it gets very
confusing when you're starting to have multiple different kinds of datasets and
information coming in. But legally, we could do it. At the right time we could address
them.
Assemblyman Gottfried: Well, I I'm glad to hear that. I think the right time is - not only
now, but several months ago, so I would hope you would do that, and if people need, as
you said, a few days to sort out what they're being asked for, gee, that's worth it.
Dr. Zucker: Well, one of the pieces of information, I raised this before is the issue of
asking for someone's date of birth and their name and as we've spoken about, we want
to be sure we protect the privacy of individuals and how information is flowing. And so,
the last thing we want to have is information that's out there and someone says, you
provided health information of individuals that that was supposed to be protected. And
as Melissa said earlier, at the speed at which things were moving was pretty fast and
still is, and we wanted to be sure that data that we received was the hospital systems- if
you're talking about the hospitals, were able to provide us with important data but also
do the job that they were doing at that time, and still do.
Assemblyman Gottfried: Yeah. DOH is very good at keeping this kind of data
confidential.
Dr. Zucker: We pride ourselves on making sure things are private.
Assemblyman Gottfried: Right, right.
Gareth Rhodes: A lot of states do not report- not a lot, but there are several states that,
I think there's nine states that don't report any Long Term Care Facility fatality data
whatsoever. I mean, we're one of a handful of states that even reporting presumed
whatsoever. There- I mean we put up a lot of data online. We're continuing trying to put
up more but it's a balance between real-time data - everyone wants yesterday's data
like this. We get it. We want it and then making sure that data is accurate at the same
time. With testing, this is similar with- there was a ramp up period with this so it is a
desire for accuracy the desire for real-time data. The New York Times did a story last
week about how Indiana went back and redid all their records. Washington State I think
took 300 fatalities off of their website and they're adding 150 back on. I mean this was a
challenge to public health departments across the United States and I would disagree
with the assessment that DOH keeps this data hidden. DOH put up huge amounts of
data on online and we continue to do so.
Assemblyman Gottfried: I was complimenting you about keeping individual patient
information confidential. Take a compliment.
Gustavo Rivera: Yeah, you got you got to hang out with him a lot more to understand
when there is snark and when there isn't. It takes a little bit- it's a little tricky sometimes
but there was no snark there. I can confirm.
Senator Skoufis: Can I ask a- it's not necessarily a nursing home specific set of
questions. It's certainly pertinent to nursing home policy, but its pertinence is sort of
macro public health policy here. And I'm just trying to understand, I think it's instructive
to what we're talking about, like how these decisions are made. I mean it was brought
up a in reference before, you know, how these decisions are made, and so for a lot of
people looking in and I'll just speak for myself but I think for a lot of Legislators too. You
know, we learn what's happening when the four of you or the five of you are on TV
every couple of days, and that's like, we think you're just making these decisions. I
found, okay, and I don't want to go into like sort of the gory details of sort of the
personnel decision-making and all that, but like the New York Times story from about a
week ago, it was pretty upsetting for me to read that these epidemiologists, public
health officials, according to New York Times left because they were sidelined or they
felt they were being sidelined, right. And so, and again, I don't really care so much about
the personnel side of that but it raises the fundamental question for me is, if they're not
making the decisions, who are? You know, I know there are some consultants I think
that are involved but like since- so just to pick an example, right, so you had these
microcluster zones that - and I host a couple of them in my district or up until recently I
did - and you guys just stopped creating these in November. I think that was like the last
round of these microcluster zones and for months we were told like this is what the
science tells us we should be doing. Instead of shutting down the whole state, the
evidence-based approach here is we just target where there is a spike in infections and
create new restrictions there. But it stopped in November, and so I guess like, just to
use this example, if you can answer like who at DOH at the staff level was involved in
signing off on creating specific zones, and then how would the decision made seemingly
to like abandon this approach given that certainly there have been spikes in
communities throughout the state since November but there haven't been new zones.
Like, just walk me through maybe that specific example. Who was involved, beyond the
four of you or five of you in developing that, in moving on from that approach, specific
names if you could at DOH, or titles? The consultants specifically, how were they
involved? Could you walk me through that example?
Melissa DeRosa: Sure, I'll take this one Senator. So, the New York Time story aside,
although I'll say that I had never heard of the five people that they came to us with. As a
reminder, there's 6,100 people that work at DOH, there's 2,100 people who work in the
Public Health Department alone and this is like seven people and then two people who
have gone to other agencies, but putting that aside for a moment. The Governor
speaks, well obviously Dr. Zucker chiefly advises us internally. The Governor speaks on
a regular basis with Dr. Fauci, and Dr. Michael Osterholm. I would say those are two of
the people that are chief advisors. We also speak with this guy, Bruce Aylward who's at
WHO, who actually, in the heat of the pandemic, we flew in from Asia and who was
staying in Albany and advising us in person. When we created the micro-clusters back
in September, if you actually remember what was going on, de Blasio came out and
said 'we're seeing spikes in these areas, we want to shut down these zip codes.' We
went back to Dr. Osterholm and pulled in Tom Frieden, whom, I'm sure you guys know
is the head of the CDC and used to be head of New York City DOH, we talked to Bruce
Aylward and we said, 'what do you guys think that we should do? How should we
handle this? Do zip codes make sense?' Then they came to us and said zip codes
aren't a way to define a region because the virus doesn't respect it really, you guys
should be looking at census tracks. And then additionally they said to us, 'you shouldn't
just be looking at the core center where the prevalence is, because the virus moves
outward, so you guys should create these buffer zones.' So, that's how we had the red,
the orange and the yellow zones and you could loosen the restrictions a little bit as they
come out. And none of this is perfect, right? Everyone was doing this in real time, but
the goal was to try to deal with the public health issue, while at the same time try to not
crush the economy, which was just starting to get up and running. So, we went to them,
we asked them, they advised us, and when we actually announced the micro-cluster
plan, we put them in the press release as three of our advisors. We ran the numbers by
them. They agreed with the strategy. Michael Osterholm was actually out on MSNBC
selling the plan as New York is leading the way and it's an innovative way of thinking
because it doesn't have to be all open or closed. And you should be keeping schools
open because schools are a place where you're not seeing dramatic prevalence. So,
honestly, we really punch up in that regard. The people at DOH are great. The Governor
gets on the phone with the top experts in the world and in the country and asks them for
advice on an ongoing basis and obviously consulting hand in glove with Dr. Zucker. I
can't name for you those people in the New York Times article. I never met them. I
understand that people are frustrated at DOH. I am frustrated. The idea that they say
that morale is low - there is a national mental health crisis going on in this country.
There are days that I don't want to get out of bed. There are days when I don't speak to
my husband, I am frustrated because the press is attacking us, you guys are attacking
us, every decision we are making is being second guessed. So, I don't deny that I'm
sure there are people at DOH who feel like they're not the voice in the Governor's ear -
they're not. To the extent that DOH is in the Governor's ear, it's Dr. Zucker, but beyond
that, we really look to Dr. Fauci, Dr. Osterholm, WHO, and on top of that, I have now
been advising the Biden administration on their transition and COVID. I have great
relationships there - you saw today we were there with Jeff Zients - and the Governor
and I are constantly now speaking to the head of the CDC, the head of the FDA and
everyone on Biden's COVID team that he has set up and created. So, to the extent that
there is bureaucratic back fighting that is going on, or frustration, that is what it is and I
will readily acknowledge that not every single opinion at DOH is being listened to by the
Governor. Those aren't the people in his ear. He is talking to the national and
international experts. He's talking to Dr. Zucker. But on the zones, that's how that model
came up and then DOH would help us put it together. So, they would take the positives.
They would draw the circle. We would then look at how far out you should draw this with
the rings around them to make sure that you were catching the potential spread that
would happen and that's how that happened. Once we got to November, we realized
quickly that positivity which had been a helpful indicator earlier, was no longer what the
standard was that was being used nationally on how you make decisions around
closures because there were a lot of people getting sick who were no longer dying. The
number of people who walked into a hospital in the spring who died was vastly larger
than the number of people who walk into a hospital in the fall and dying. And so you
didn't have to necessarily make the decision based on cases, we pivoted and started
doing it based on hospital capacity. The decision was made that government's role
needs to be about hardening the hospital system and making sure the decisions that we
were making are going to keep the hospital system up and running, unlike what you say
in Texas and California and in Nevada and Arizona where the hospital systems actually
collapsed on themselves. So, in consultation with Dr. Osterholm, with Dr. Fauci, we said
'does this make sense?' And then we actually did a press conference where we talked
about how we were hardening the system going into the second wave and Dr. Fauci
participated in that press conference and the Governor presented his plan and he gave
his approval. So, to the extent that you're curious as to he talks to constantly and who is
in his ear, those are the people. And then Dr. Zucker obviously represents his
Department to senior staff and to the Governor in day to day decision making.But on
your point to not getting more notice on decisions that are being made, that's something
I've actually spoken to Shontell and Louann about as well and now that you guys are
back in session, especially now that things are a bit more manageable, we talked about
doing weekly briefings at the central staff level to make sure they have access to
everybody here, so they know what we are thinking, when we think decisions are going
to be made. But I'm not going to lie, some things are done on the fly based on the
information we have that morning and that's never going to be completely ironed out,
but to the extent that we can minimize that, we will strive to.
Senator Skoufis: I appreciate that and you answered my question. Just to close the
loop on it, so can you just discuss -- so I know that there are these consultants in the
background that the state has brought on, can you tell us what they do and who they
are?
Melissa DeRosa: Well, I'll have Robert discuss this more at length, but in my opinion,
they're sort of our number crunchers, but go ahead Robert.
Robert Mujica: We have a few consultants, the main one is Boston Consulting Group
and what they're doing is just providing us with data analysis, right? So, what they're
doing is they are benchmarking for us what's going on across the country, across the
world, and we get reports from them about -- every day we're looking at infection rates
around the country, infection rates around the world, what are policies other countries
are doing, what are policies other states are doing and gathering all of that information.
They are benchmarking what are the guidelines and restrictions that other states are
doing on a regular basis. And they're not making any decisions, they're just informing
our dialogue. If you ask, if you look at health care professions, epidemiologists,
departments of health in every single state and every single state has a different answer
on how you deal with this and how you deal with that. You look across the country and
that's what we ask them for. 'How is this state dealing with gyms? How is this state
dealing with restaurants?' They're collecting all of that information and then using that to
inform the guidelines and restrictions, but every single guideline that we have put out on
restrictions, has to be approved by the Department of Health staff and then by Dr.
Zucker. Every single one. Now, there's some people in the department that don't like the
fact that they have a different opinion on how you do this, right? And even the people
that Melissa talks to -- I talked to Dr. Zucker almost every single day and every single
day we talk about why they are doing it this way in this country, and why are they doing
it this way in this state. Now, Beth just sent me an email while we're sitting here - 'Fauci
just said we need to wear two masks.' You know, we have video of him saying everyone
should wear - nobody should wear a mask eight months ago. Now, he is saying wear
one mask, now wear two masks and it changes all the time. Put up barriers - we have
these, right? CDC just put out a report that said these might be harmful because they
don't allow air to circulate, right? So, that is what these consultants do. If you ask all of
these professionals, right? They all have often different opinions. We had this
discussion, the other day Dr. Zucker says to me the problem is there is no right answer
for all of these things. So, they are people that we rely on for data analysis, they provide
us information, we have daily phone calls - twice a week phone calls, with seven other
states that are around us in the seven state coalition. At 8 a.m. we get on the phone
with them twice a week and go through with them - 'What is your state doing? What
does your state seeing?' So, we have that group, and then we have the national group
and then we have conversations with the world professionals and if you look at what
everyone is doing - everyone is doing it differently and people are getting different
results and we're just trying to stay like - see what are we doing, what is every other
state doing and what is the best practice for reopening the economy and doing it safely
and all of those people - we are having those discussions. But again, there hasn't been
a single guideline that we have put out that hasn't been signed off on by the
professionals at the Department of Health, by Zucker. But we do pressure test them. I
can tell you that, like we do. Someone comes and says -- and is not a health care
professional, right, and they come up with 'well we think we should this' and we push
back, right? We push back. We say, well why? What about this state? What are they
doing it this way? What are they doing it that way? Some people don't like that, but we
think we end up with a better result by doing it, but that's what it all is and we do consult
with them, but as Melissa points out, not every single person's opinion prevails all the
time.
Senator Skoufis: Thank you. And just to be clear, Boston Consulting and these groups
that you have hired, they are not involved whatsoever in the public health decision
making process here, right? Is that accurate?
Melissa DeRosa: Yup, I'll give you a direct answer. Nope. They literally - just Senator
so you get a sense of it - I'll send an e-mail at 2 o'clock in the morning and say 'I need
by 9 a.m. a matrix of what every state is doing on stadiums. I want to know how many
how many are allowed inside. I want to know how many are allowed outside, and I also
want columns of what their hospitalization capacity is and their positivity, by 9.' They will
write me back at 4 a.m. and say 'confirmed' and by 8:58 a.m., I'll have it in my inbox. I
genuinely, and I don't mean this to be demeaning, they are our on demand number
crunchers, search for data, pull this information - but in no way, shape or form are they
involved in any level of decision making beyond providing us with context and data so
that we can make decisions.
Dr. Zucker: I just want to add one more thing about information and how it comes in for
me from other places. So, every Tuesday morning, I wake up to a call with two of our
neighboring states - New Jersey and Connecticut - the three Commissioners. The three
of us discuss what is going on. Once a week, the region from Maine all the way down to
Pennsylvania, actually New Jersey/Pennsylvania, we have a conversation about what's
happening the in the region and every week all the Commissioners from across the
country have a conversation about what's going on. So, that's how we get information
from everywhere and then one every week or two, I speak to the WHO.
Senator May: So, let me follow up on this because one thing we know about the
disease is it hits older people and it hits people in congregate care and I talk frequently
to Dr. Sharon Bragman at Upstate who is the Chief of Geriatrics there and she said to
me that they don't, there is nobody with a geriatric specialization advising the Governor
and I know I've gotten a response from you on that, that you talk to AARP and a lot of
other groups, but that doesn't feel quite like an answer to me, especially when we're
thinking of when you know this about the disease, that would be an obvious area of
expertise to add to your team. Was there any consideration of that? Is there anybody
that you can think of who is really an expert that you turn to?
Dr. Zucker: Well, I can answer because I have spoken with, not in a formal way, but
many of these conversations are informal, with many individuals who are experts in the
area of geriatric medicine, including one who is the dean of one of our public health
schools here in New York is a geriatrician and also some of the foundations that are
focused primarily on long term care. And those relationships have been established
even prior to COVID because we were addressing a lot of the issues, the problems and
looking at many of the issues about the elderly population and what we can do for them
for health care, whether it's telehealth, telemedicine and things of that nature. So, those
were already formed. Remember, New York is the first age-friendly state. We were
working on that with some of the foundations in other parts of the state as well as in
New York, and that's how the AARP part came in. But she is an excellent physician and
I do know her and I am happy to reach out to her as well.
Senator May: And one other issue that just came to me this afternoon because I met
with the occupational health clinic organization and they're obviously looking for money
in the budget, but one of the things that they pointed out is that mental health care is
almost impossible to get as a disability thing. And I'm thinking people working in nursing
homes, the likelihood that a lot of them are going to have trauma from their work - work-
related disability - and in the mental health sphere and it's incredibly hard to get that
covered or provided. I'm just wondering if you all have thought about this issue moving
forward? How are we going to help beef up the mental health support for people and is
there any chance of streamlining the occupational health disability system so that more
providers are likely to take that.
Dr. Zucker: So, we have had conversations with Commissioner Sullivan and the Office
of Mental Health about this and I think it's more than just the nursing home community. I
am actually concerned about this in the big picture, because, we have taken the social
fabric and we turned it around and turned it inside out, and we've made a lot of changes
to the way we live and it's not for a month or two, but it's over a year, close to a year, in
some parts of the country it's over a year. I think we need to address this and address it
for both kids who are in school. So it's not just, you know, that end of the spectrum, it's
right across the spectrum and figure out what we need to do. There are many health
professionals who have seen things which have really been a challenge to their own
mental health as well and we need to address that and I think that going forward, this is
something that we need to focus on and then it comes back to the budget issue, but
Commissioner Sullivan and I have spoken about that.
Senator May: Great, thanks. I don't think I have anything more.
Melissa DeRosa: Anything else? I mean obviously, this is not the end of the
conversation. This is more like the beginning, but for now, is there anything else?
Senator Skoufis: I just want to say that I have found this - I've been doing this for nine
years, third year in the Senate, and I have found this really refreshing. And I am being
perfectly honest - I have just not felt in nine years, sort of the, this sort of opportunity to
have an honest and straightforward conversation where I've felt that, you know, you all
weren't just reading from a script or trying to dance around questions. I feel really good
about what happened tonight, and maybe I'm speaking out of school with my colleagues
still on the Zoom here, but I just ask, like, can this please be the standard? This in my
mind is how it is supposed to work. I think in my mind, we were brutally honest at times
and you were forthright and when you didn't like what we were doing, you let us know
that and you, I think, you genuinely answered most, if not all, of our questions to the
extent that you could. So, I just ask that this be the standard, that's all.
Dr. Zucker: Thank you.
Melissa DeRosa: You have my word. Look, I know the position that you guys have
been put in with some of this and I know that more than anything, it's just that the press
comes to you and your constituents come to you have you have to be able to have
answers. And I've talked to Shontell and Louann and I really appreciate, for the most
part, that the legislature has been supportive throughout this process. It's been really
been hard for all of us, we're all just trying to do the right thing, but I want to continue
this dialogue in whatever format makes sense. You know, I defer to your leadership
obviously, but I'm here, I will make the time. The people around this table will make the
time and we're happy to continue this.
Skoufis: Ok, thank you.